Retransplantation Rate Research Articles

Orthotopic Implantation Achieves Better Engraftment and Faster Growth Than Subcutaneous Implantation in Breast Cancer Patient-Derived Xenografts

Patient-Derived Xenograft (PDX) is now accepted as a murine model that better mimics human cancer when compared to a conventional cancer cell-line inoculation model. Some claim the advantage of orthotopic site implantation of patient tumor (OS) over ectopic implantation into the subcutaneous space (SQ); however, there has been no study that describes a head-to-head comparison of oncological differences between these two models to date. We hypothesize that OS tumors re-transplant and grow better than SQ tumors and are therefore a better model to evaluate tumor aggressiveness. Breast cancer PDXs were generated using the tumors derived from 11 patients into NOD scid gamma (NSG) mice. We used six ER(+)HER2(-) tumors and five triple negative (TN) tumors for a total of 11 tumors. Five PDX lines grew for an overall engraftment rate of 45%. We present our OS implantation method in detail. The re-transplantation rate of TN tumors in each transplant site was significantly higher in OS when compared to SQ tumors (70.1% vs. 32.1%, p < 0.01). OS tumors grow significantly faster than SQ tumors. Similarly, OS tumors demonstrated significantly more mitotic figures and Ki-67 positive cells than SQ tumors. The tumor re-transplantation rate significantly increased by the second and third generations with the OS method. The time from implantation to development of a palpable tumor dramatically decreased after the first passage. PDX of ER(+) tumors demonstrated significantly lower engraftment rates and slower tumor growth than TN tumors, which remarkably improved by the first passage. Orthotopically implanted PDX tumors showed better re-transplantation rates, greater tumor size, and more significant growth compared to the subcutaneously implanted model.

Does HLA matching matter in the modern era of renal transplantation?

Children with end-stage kidney disease should be offered the best chance for future survival which ideally would be a well-matched pre-emptive kidney transplant. Paediatric and adult practice varies around the world depending on geography, transplant allocation schemes and different emphases on living (versus deceased) donor renal transplantation. Internationally, paediatric patients often have priority in allocation schemes and younger donors are preferentially allocated to paediatric recipients. HLA matching can be difficult and may result in longer waiting times. Additionally, with improved surgical techniques and modern immunosuppressive regimens, how important is the contribution of HLA matching to graft longevity? In this review, we discuss the relative importance of HLA matching compared with donor quality; and long-term patient outcomes including re-transplantation rates. We share empirical evidence that will be useful for clinicians and families to make decisions about best donor options. We discuss why living donation still provides the best allograft survival outcomes and what to do in the scenario of a highly mismatched living donor.

Increased Posttransplant Mortality for Autoimmune Hepatitis Compared With Other Autoimmune Liver Diseases.

We sought to compare posttransplant outcomes between autoimmune liver disease. Autoimmune liver diseases, namely primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis (AIH) generally have favorable posttransplant outcomes. PSC is known to require more retransplantation compared with PBC, however, comparisons to AIH are lacking. We sought to compare graft survival and the need for retransplant in AIH compared with other autoimmune liver disease. We compared posttransplant graft survival among the 3 entities using Cox regression and competing for risk analyses using the United Network for Organ Sharing (UNOS) database. We found AIH is associated with significantly decreased graft survival compared with PBC [hazard ratio: 0.86; 95% confidence interval (CI): 0.77-0.96] and PSC (hazard ratio: 0.89; 95% CI: 0.8-0.99) after controlling for potential confounders. This is mainly driven by posttransplant death. On competing for risk analysis, AIH was associated with higher risk of death compared with PBC [subdistribution hazard ratio (SHR): 0.79; 95% CI: 0.7-0.89] and PSC (SHR: 0.72; 95% CI: 0.64-0.82) and lower risk of retransplant compared with PSC (SHR: 1.48; 95% CI: 1.19-1.8). As prior studies have shown the similar risk of disease recurrence in AIH and PSC, our study indicates at least part of the increased posttransplant mortality in AIH may be due lower retransplantation rate in this population.

1010 Risk Factors for Recurrent Primary Sclerosing Cholangitis (rPSC) After Orthotopic Liver Transplant

INTRODUCTION: Recurrent primary sclerosing cholangitis after liver transplantation occurs in approximately 10-25% of patients. rPSC is the leading cause of graft loss and mortality and significantly increases the need for retransplantation. Prior studies have suggested that Inflammatory bowel disease (IBD) with an intact colon is risk factor for the development of rPSC. Our aim was to evaluate whether IBD with or without a colectomy significantly affected the development of rPSC, identify other risk factors for recurrence, and define the overall recurrence rate. METHODS: In this ongoing single center, retrospective cohort, 1086 transplants were performed at University of Cincinnati between 2003 to 2019. rPSC was defined using the Mayo Clinic criteria. A total of sixteen risk factors were considered including: age, gender, type of anastomosis, type of transplant, hepatic artery thrombosis, acute cellular rejection, IBD, type of IBD, colectomy, timing of colectomy, cholangiocarcinoma, MELD score, cold ischemic time, hepatitis B core antibody donor status, and smoking. Data were analyzed using Statistix 10.0 with an alpha = 0.05. RESULTS: 53/1086 liver transplants (4.9%) were performed in 48 patients for primary sclerosing cholangitis (PSC). Within the PSC group, the median age at transplant was 49 years with 72.5% male. The median MELD at transplant was 22, median cold ischemic time of 363 minutes, and a median follow-up of 47.5 months. 35 patients (68.6%) had IBD including 20 (57.1%) with ulcerative colitis. 9 patients (18.4%) developed rPSC in a median of 65 months. Among these, 67% developed subsequent graft loss from rPSC and 33% underwent retransplant (P &lt; 0.03). As anticipated, HAT was a negative predictor for development of rPSC. There were no statistically significant risk factors for the development of rPSC, but rPSC patients were slightly younger (P &lt; 0.06). In rPSC, graft loss (P &lt; 0.004) and time to death (P &lt; 0.007) occurred significantly later (107 and 102 months respectively) than in patients without rPSC. CONCLUSION: The overall recurrence rate of PSC (18.4%) is similar to prior studies without any discernable risk factors in this cohort. IBD and colectomy did not significantly reduce the rate of rPSC. rPSC leads to delayed graft loss and mortality with a high rate of retransplantation indicating an insidious disease process. Longer follow-up may increase the rate of rPSC, graft loss and mortality as a subset of individuals in the cohort were transplanted prior to the median recurrence time.

Five-Year Graft Survival and Clinical Outcomes of 500 Consecutive Cases After Descemet Membrane Endothelial Keratoplasty.

To report the 5-year graft survival and clinical outcomes after Descemet membrane endothelial keratoplasty (DMEK). A retrospective, interventional case series was performed at a tertiary referral center. Five hundred eyes of 393 patients that underwent DMEK for Fuchs endothelial corneal dystrophy, bullous keratopathy, failed previous corneal transplants other than DMEK, or other indications were evaluated for graft survival, best-corrected visual acuity (BCVA), endothelial cell density, postoperative complications, and retransplantation rate. Kaplan-Meier analysis demonstrated an estimated survival probability of 0.90 [95% confidence interval, 0.87-0.94] for the entire cohort at 5 years after DMEK. At this time point, 82% of the eyes achieved a BCVA of ≥20/25 (0.8), 54% achieved ≥20/20 (1.0), and 16% achieved ≥20/17 (1.2). BCVA continued to improve from 6 to 36 months after DMEK surgery (P ≤ 0.005) and then remained stable up to 60 months postoperatively (P > 0.08). Preoperative donor endothelial cell density averaged 2530 (±210) cells/mm and decreased by 37% at 6 months, 40% at 1 year, and 55% at 5 years after DMEK surgery (P < 0.001 between all follow-up time points). During the study period, allograft rejection episodes developed in 2.8% of the eyes, primary graft failure occurred in 0.2%, and secondary graft failure in 2.8% of the eyes. Re-keratoplasty was required in 8.8% of the eyes. Five-year graft survival after DMEK is high, and visual acuity outcomes remain excellent and are accompanied by a low longer-term complication rate.

Characteristics and Outcomes of Liver Transplantation for Primary Biliary Cholangitis in Young Patients: Analysis of the United Network for Organ Sharing Database.

Primary biliary cholangitis (PBC) in younger patients has been suggested to require liver transplantation (LT) in early adulthood, but data is limited on its outcomes. We aimed to evaluate the characteristics and outcome of LT in young patients with PBC in comparison with older adults. The United Network for Organ Sharing database was analyzed for all patients with PBC who underwent LT between 2000 and 2012. Based on age at the time of LT, subjects were divided into 2 groups: young patients (≤40 y) and older adults (≥41 y). Baseline demographics, clinical parameters, and outcomes of LT were then compared between the 2 groups. Univariable and multivariable analyses were performed to assess the factors associated with outcomes of LT. A total of 2084 patients with PBC were included in the analysis with 158 young patients. Compared with older adults, younger patients were more likely to be male (27.2% versus 15.4%) and nonwhite (43.7% versus 21.5%), but they were less likely to have obesity, diabetes, or hypertension (P < 0.05) and had a lower mortality (8.2% versus 15.1%) but higher retransplantation rate (14.6% versus 4.7%) (P < 0.001). On multivariable analysis, older age, dialysis or ventilator use, and lower albumin were associated with high post-LT mortality. Compared with older adults, early-onset PBC in younger patients requiring LT had higher percentage of males and nonwhites and had a lower prevalence of metabolic comorbidities but higher retransplantation rates. Further studies are warranted to confirm these findings.

The causes and prognosis of allograft nephrectomy during the perioperative period

Objective To analyze the reason of renal allograft resection after kidney transplantation and after the prognosis. Methods Retrospectively analysis of data of eleven cases involved with early resection of kidney transplantation from January 2009 to May 2017 was performed.The causes of nephrectomy, the complications and prognosis after nephrectomy as well as the subsequent renal transplantation were collected. Results All the patients were followed up for 6-48 months. The reasons for the nephrectomy included hyper acute rejection(2 cases), kidney artery/vein thrombosis(2 cases), kidney infection(4 cases) and bleeding(3 cases). Three patients died, and the remaining 8 patients returned to dialysis. The PRA had been elevated to a high level with different degree. The patient had no will to perform the kidney transplant again during the follow-up period. The reasons included the higher PRA, the loss of confidence for the operation, and the cost. Conclusions The reasons for the early resection of kidney transplantation include HAR, renal artery/vein thrombosis, transplantation of kidney infection. The rate of retransplantation is very low after the failure of the first kidney transplantation. Key words: Kidney Transplantation; Nephrectomy; Intraoperative Period

Persistent acidosis after reperfusion-A prognostic indicator of increased 30-day and in-hospital postoperative mortality in liver transplant recipients.

During liver transplantation, the patient is at risk of developing progressive lactic acidosis. Following reperfusion, correction of acidosis may occur. In some patients, acidosis will worsen, a phenomenon referred to as persistent acidosis after reperfusion (PAAR). We compared postoperative outcomes in patients who manifested PAAR vs those that did not. All adult patients undergoing liver transplantation from 2002 to 2015 were included. PAAR is defined by the presence of a significant negative slope coefficient for base excess values measured after hepatic artery anastomosis through 72hours postoperatively. Primary outcome was a composite of 30-day and in-hospital mortality. Secondary outcomes included: ICU LOS, total hospital LOS, and re-transplantation rate within 7days. PAAR occurred in 10% of the transplant recipients. Patients with PAAR had higher MELD, BMI, and eGFR and demonstrated a longer median ICU LOS and hospital median LOS with a trend toward mortality difference. But, after propensity matching, the mortality rate difference became significantly higher in patients with PAAR compared with matched controls while the ICU LOS differences disappeared. The re-transplantation rates were similar also between the PAAR and no PAAR groups. The cohort with PAAR had a significant 30-day and in-hospital increase in mortality after propensity score matching.

Systematic Review and Meta-Analysis on the Impact of Thrombolytic Therapy in Liver Transplantation Following Donation after Circulatory Death.

Aim: The livers from DCD (donation after cardiac death) donations are often envisaged as a possible option to bridge the gap between the availability and increasing demand of organs for liver transplantation. However, DCD livers possess a heightened risk for complications and represent a formidable management challenge. The aim of this study was to evaluate the effects of thrombolytic flush in DCD liver transplantation. Methods: An extensive search of the literature database was made on MEDLINE, EMBASE, Cochrane, Crossref, Scopus databases, and clinical trial registry on 20 September 2018 to assess the role of thrombolytic tissue plasminogen activator (tPA) flush in DCD liver transplantation. Results: A total of four studies with 249 patients in the tPA group and 178 patients in the non-tPA group were included. The pooled data revealed a significant decrease in ischemic-type biliary lesions (ITBLs) (P = 0.04), re-transplantation rate (P = 0.0001), and no increased requirement of blood transfusion (P = 0.16) with a better one year graft survival (P = 0.02). Conclusions: To recapitulate, tPA in DCD liver transplantation decreased the incidence of ITBLs, re-transplantation and markedly improved 1-year graft survival, without any increased risk for blood transfusion, hence it has potential to expand the boundaries of DCD liver transplantation.

Left-liver Adult-to-Adult Living Donor Liver Transplantation: Can It Be Improved? A Retrospective Multicenter European Study.

To evaluate the European experience after Adult-to-adult living donor liver transplantation using the left liver (LL-aLDLT). LL-aLDLT decreases donor risk but provides a smaller graft that increases recipient risk as compared with right liver (RL-aLDLT). However, there is little knowledge of results obtained after LL-aLDLT in Europe. This is a European multicenter retrospective study which aims to analyze donor and recipient outcomes after 46 LL-aLDLT. Seventy-six percent of the grafts were harvested by minimally invasive approach. Mean donor hospital stay was 7.5 ± 3.5 days. Donor liver function was minimally impaired, with 36 donors (78.3%) without any 90-day complication, and 4 (8.7%) presenting major complications. One, 3, and 5-year recipient survival was 90.9%, 82.7%, and 82.7%, respectively. However, graft survival was of 59.4%, 56.9%, and 56.9% at 1, 3, and 5 years respectively, due to a 26.1% urgent liver retransplantation (ReLT) rate, mainly due to SFSS (n = 5) and hepatic artery thrombosis (HAT, n = 5). Risk factor analysis for ReLT and HAT showed an association with a graft to body weight ratio (GBWR) <0.6% (P = 0.01 and P = 0.024, respectively) while SFSS was associated with a recipient MELD ≥14 (P = 0.019). A combination of donor age <45 years, MELD <14 and actual GBWR >0.6% was associated with a lower ReLT rate (0% vs. 33%, P = 0.044). Our analysis showed low donor morbidity and preserved liver function. Recipient outcomes, however, were hampered by a high ReLT rate. A strict selection of both donor and recipients is the key to minimize graft loss.

Analysis of indications and survival in liver retrasplantation

Background: Liver re-transplantation (re-LT) has an incidence of between 10% and 22% of total liver transplants (LT). These procedures are associated with increased risk and worse long-term survival than primary liver transplantation. Methods: We present a retrospective study of 100 re-LT performed from January 1990 to December 2016 with a minimum follow-up of 6 months after re-LT. Patients were divided into two groups depending on the urgent/elective nature of re-LT analyzing the causes that motivated them and their survival. Results: In our series, a total of 1234 TOH were performed in 1134 patients, with 100 re-LT the rate of re-transplantation in our series is 8.1%. Conclusion: The overall survival of the patients in our series was 11.10 years ± 1.21 years. We found that the survival of urgently re-transplanted patients is greater than that of electively re-transplanted patients (15,194 ± 1.71 vs 7.92 ± 1.10 days with p 0.02).

Long-term outcomes using uncontrolled donors after circulatory death (DCD) for liver transplantation. A 10-year single center experience

Introduction: Number of liver grafts is not enough to attend all patients who need an OLT. Many OLT teams have proposed to expand the number of available grafts using livers from donors after circulatory death (DCD). We aim to analyse the use of liver grafts from type 2 uDCD donors for OLT, comparing with a group of patients who received liver grafts from donors after brain death (DBD). Patients and methods: Between January 2006 and December 2016 we performed 783 OLT in adult recipients. 75 of these transplants were DCD (Maastricht type II). We compared thus 75 DCD with 265 optimal donors OLT. Results: We present 75 DCD with a mean age 58.8 ± 8 vs 54.7 ± 10; p = 0,000, no different has found according to gender, body mass index, Child, MELD neither OLT indication. Donor age was 41.7 ± 10 vs 47.8 ± 15;p = 0.001; No different has found in Esteatosis, neither preservation injury, or cold ischemia time. Warm ischemia time was faster in DCD 62 min ± 14 vs 70 ± 36 (p = 0,010). Transfusion rate was significally higer in DCD in RBC, FFP, platelets and fibrinogen. Primary graft failure was higher in DCD 8.1% vs 2.1% (p = 0,031), also retransplant rate 12% vs 4.6% (0,028) and ischemic cholangiopathy 31,1% vs 5,6% (p = 0,000). Patient survival at 1, 3 and 5 years was in DCD: 81,3%, 70,2% and 68,6% vs DBD 89%, 83,7% and 78,8% p = 0,070. Conclusion: Even with a higher risk of primary graft failure and ischemic cholangiopathy, DCD type II is a safe source of donor for liver transplantation.

A systematic review and meta-analysis of rescue revascularization with arterial conduits in liver transplantation.

Although aortohepatic conduits (AHCs) provide an effective technique for arterialization in liver transplantation (LT) when the native recipient artery is unusable, various publications report higher occlusion rates and impaired outcome compared to conventional anastomoses. This systematic review and meta-analysis investigates the published evidence of outcome and risk of AHCs in LT using bibliographic databases and following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Primary and secondary outcome were artery occlusion as well as graft and patient survival. Twenty-three retrospective studies were identified with a total of 22113 patients with LT, of whom 1900 patients (9%) received an AHC. An AHC was used in 33% of retransplantations. Early artery occlusion occurred in 7% (3%-16%) of patients with AHCs, compared to 2% (1%-3%) without conduit (OR 3.70; 1.63-8.38; P=.001). The retransplantation rate after occlusion was not significantly different in both groups (OR 1.46; 0.67-3.18; P=.35). Graft (HR 1.38; 1.17-1.63; P<.001) and patient (HR 1.57; 1.12-2.20; P=.009) survival was significantly lower in the AHC compared to the nonconduit group. In contrast, graft survival in retransplantations was comparable (HR 1.00; 0.82-1.22; P=.986). Although AHCs provide an important rescue option, when regular revascularization is not feasible during LT, transplant surgeons should be alert of the potential risk of inferior outcome.

Returning to Dialysis after Kidney Transplant Failure. Does the Dialysis Treatment Modality Influence the Survival Prognosis?

Background Haemodialysis (HD) and peritoneal dialysis (PD) survival results are similar, but there are just a few survival studies about the return to renal replacementent therapy (RRT) after renal transplantation (RT), additionally, these studies are quite uncertain. Methods Retrospective cohort study including patients who returned to dialysis (HD or PD) after first kidney transplantation from 01/01/2006 to 31/01/2017. Deceased <90 days after restarting dialysis were excluded. Demographic characteristics, time in RRT, modality of therapy before and after transplantation, Charlson comorbidity index (CCI) and cause of death were analyzed. Survival was calculated till: the end of the study, death, new transplantation or change in dialysis treatment modality. Results 165 patients were included. 149 of them return to HD (HD-group) and 16 return to PD (PD-group). Before transplantation, 93.8% of PD-Group used peritoneal dialysis as RRT while only 84.6% used haemodialysis in HD-group (p<0,001). Average age at allograft failure was 54.1±6.2 in PD-group and 59.5±12.5 in HD-Group (p=0,032) with a CCI of 4,4±2,1 in PD-group vs. 5,9±2,5 in HD-group (p=0,027). A RRT modality change was necessary in 5 (31%) at PD-group vs 4 (2%) at HD-Group (p<0,001). The average time to the change of modality was similar in both cases (921 vs. 914 days, ns). Low dialysis doses (1), catheter problems and late peritonitis episodes (3, time to first episode of peritonitis: 1338 days) were the causes of change at PD-group, however all patients who changed RRT modality in HD-group suffered vascular access problems. Survival prognosis, even adjusted by CCI, death causes and re-transplantation rate had no statistically significant difference. Discussion After allograft failure, haemodialysis is the RRT chosen by most patients. Those who chose peritoneal dialysis used the same therapy before transplantation in the majority of cases. Despite of the fact that patients that chose peritoneal dialysis were younger and had less comorbidities, survival prognosis and re-transplantation rate were similar to haemodialysis patients.

Risk Factors and Consequences of Ischemic Cholangiopathy in Liver Transplantation from DCD Maastricht IIA

Introduction Although donors after cardiac death (DCD) Maastricht type IIA have been established as an acceptable source of grafts in the current setting of organ shortage, biliary complications, especially ischemic cholangiopathy (IC), remain a considerable difficulty in the management of these patients, with a significant impact in long term results and quality of life. Objectives To study the incidence and impact of ischemic cholangiopathy among DCD IIA liver transplant recipients, and identify risk factors related to this complication. Materials and Methods Retrospective analysis of the DCD Maastricht type IIA liver transplantation series in University Hospital 12 de Octubre, registered from January 2006 to December 2016. Results 75 LT from DCD type IIA were performed during the study period, with 23 cases of IC diagnosed (30.7%). Comparing patients who suffered this complication (IC) with those who did not (no-IC), there were no significant differences found in recipient age (no-IC 58.4+7.7, IC 59.5+7.7 years), MELD score (no-IC 13.9+4.8 vs IC 15.6+4.8), donor age, HCV infection or hepatocellular carcinoma prevalence. Mean MELD-Na was 19+7 in those patients who developed IC, and 15.9+5.8 in those who did not, although the difference was not significant. Ischemia times and ECMO flow rates were similar in both groups. Retransplantation rate was higher in the no-IC group (11.5% vs. 13%, NS). No differences were achieved comparing liver function tests. Median time from transplantation to development of ischemic cholangiopathy was 5.8 months (range 1.2-70.3). Multivariate analysis shows an increased risk of IC in those grafts with AST levels over four times the upper limit of the normal range in the last blood sample obtained during NECMO (OR, 5.93; 95% CI, 1.001-35.208; p 0.05). No other statistically relevant risk factors were identified in this analysis. Differences found when comparing actuarial survival at 1, 3 and 5 years in recipients who did not develop IC (76.5%, 70.3% and 70.3%) with those who did (91.3%, 69.6% and 65.2%) were not statistically significant (p 0.915). Similar results were obtained when studying graft survival (no IC 70.6%, 64.3%, 64.3% vs. IC 78.3%, 60.9%, 56.5%; p 0.958). Conclusions AST levels 4 times above the usual laboratory range have been identified as a significant risk factor in the developement of ischemic cholangiopathy, suggesting that grafts with this characteristic should be discarded to minimize said complication.

Donation After Cardiac Death in Liver Transplantation: An Additional Source of Organs With Similar Results to Donation After Brain Death

BackgroundAs new sources of organs are needed, liver transplantation using donors after cardiac death (DCD) is progressively increasing, but outcomes with this method are still questioned. This study was accomplished to verify that DCD outcomes are comparable to those seen in donation after brain death (DBD). MethodsThis was a prospective cohort study including 100 liver transplantation performed between 2014 and 2017, divided according to donor type in 75 DBD and 25 DCD. ResultsDCD donors were younger (mean age: DCD 56 years, DBD 59 years; P = .009). Mean Modified End-stage Liver Disease (MELD) score was lower for DCD (DCD 16, DBD 19; P < .001). No differences were found regarding ischemia times and development of postreperfusion syndrome or coagulopathy. Primary graft dysfunction was more frequent in DCD (60%, DCD 29.3%; P = .006). Rates of primary graft nonfunction (DCD 0%, DBD 1.3%; P = .562) and acute rejection (DCD 20%, DBD 16.4%; P = .685) were similar. Acute kidney injury occurred more often in DBD (DCD 32%, DBD 12%; P = .051). Length of stay was comparable. Rates of biliary complications (DCD 20%, DBD 26.7%; P = .505) were similar, unlike ischemic cholangiopathy (DCD 12%, DBD 1.3%; P = .018). Retransplantation rates were also similar (DCD 8%, DBD 4%; P = .427) as was survival rate after 3 years (DCD 84%, DBD 86.7%; P = .739). ConclusionDCD represents an additional graft source with results that are encouraging and may be comparable to DBD with a careful donor and recipient selection.

Liver Transplant From Controlled Cardiac Death Donors Using Normothermic Regional Perfusion: Comparison With Liver Transplants From Brain Dead Donors

BackgroundLiver transplantation from donors after either controlled or uncontrolled cardiac death (DCD) is associated with considerable rates of primary nonfunction (PNF) and ischemic cholangiopathy (IC). Normothermic regional perfusion (NRP) could significantly reduce such rates. MethodsRetrospective study to analyze short-term (mortality, PNF, vascular complications) and long-term (IC, survival) complications in 11 liver transplants from controlled DCDs using NRP with extracorporeal membrane oxygenation (ECMO) (group 1). They were compared with 51 patients transplanted with grafts from donors after brain death (DBD) (group 2). Mean recipient age, sex, and Model for End-stage Liver Disease (MELD) score were not significantly different. ResultsIn group 1, mean functional warm ischemia time was 15.8 (range, 7–40) minutes and 94.1 (range, 20–150) minutes on NRP. The ischemic damage was minimal, as shown by the slight alanine aminotransferase (ALT) and aspartate aminotransferase (AST) rises in the donor serum after 1 hour on NRP and similar rises 24 hours after transplantation in both groups. No patient had IC or acute renal failure. No significant difference was found between the groups for vascular or biliary complications. One group 1 patient had PNF (9.1%), resulting in death. Overall retransplantation and in-hospital death rates were 8.1% and 4.8%, respectively, with no significant difference between groups. Estimated mean survival was 24.6 (95% confidence interval [CI], 20.2–29.1) months in group 1 and 32.3 (95% CI, 30.4–34.2) months in group 2 (not a statistically significant difference). ConclusionIn our experience, liver transplants from controlled DCDs using NRP with ECMO is associated with a low risk of PNF and IC, with short- and long-term results comparable to those in DBD transplants.

Assessment of a Dedicated Transplant Low Clearance Clinic and Patient Outcomes on Dialysis After Renal Allograft Loss at 2 UK Transplant Centers

BackgroundLow clearance transplant clinics (LCTCs) are recommended for the management of recipients with a failing kidney transplant (RFKT) but data to support their use is limited. We conducted a retrospective study to assess management of RFKT at 2 transplant centers, 1 with a LCTC (center A) and 1 without (center B).MethodsPatients who transitioned to an alternative form of renal replacement therapy (RRT) between January 1, 2012, and November 30, 2016, were included. Patients with graft failure within a year of transplantation or due to an unpredictable acute event were excluded. Clinical data were collected after review of medical records.ResultsOne hundred seventy-nine patients (age, 48.6 ± 13.4 years, 99 [55.3%] male, and mean transplant duration 10.3 ± 7.8 years) were included. RRT counseling occurred in 79 (91%) and 68 (74%) patients at centers A and B (P = 0.003), at median 135 (61-319) and 133 (69-260) days before dialysis after graft loss (P = 0.92). Sixty-one (34.1%) patients were waitlisted for retransplantation; 18 (32.7%) nonwaitlisted patients were still undergoing workup at center A compared with 37 (58.7%) at center B (P = 0.028). Preemptive retransplantation occurred in 4 (4.6%) and 5 (5.4%) patients at centers A and B (P = 0.35). At 1 year after initiation of dialysis after graft loss, 11 (15.3%) and 11 (17.2%) patients were retransplanted (P = 0.12), and mortality was 6.6% overall.ConclusionsA dedicated LCTC improved RRT counseling and transplant work-up but did not lead to improved rates of retransplantation. Earlier consideration of retransplantation in LCTCs is required to improve RFKT outcomes.

1000 Consecutive Liver Transplants. Descriptive Analysis and Evolution of a Single Center

Between 1991 and 2013, 1000 liver transplantations were performed at Virgen del Rocio Hospital (Seville, Spain). A retrospective study was conducted, analyzing the characteristics of recipients and donors, indications, surgical technique, complications and survival in 2 different stages (1991–2002 vs 2003–2013) coinciding with the implementation of the MELD scale as a prioritization model. The most frequent indication was of hepatopathy of hepatocellular origin in 48.8%. There was a significant increase in the indications for hepatocarcinoma (8.6% and 24.1% P=.03), and the rate of retransplantation (5.9% vs 9.6%, P=.04). There was a change in the age of donation, going from 27.7 years in 1990 to 62.9 years in 2012 (P=.001). The percentage of patients who did not require blood transfusion doubled (6.16% vs 14.31%, P=.001). Survival of all patients after 1, 5 and 10 years was 77%, 63.5% and 51.3%, respectively.

1000 trasplantes hepáticos consecutivos. Análisis descriptivo y evolución de un centro

Between 1991 and 2013, 1,000 liver transplantations were performed at Virgen del Rocio Hospital (Seville, Spain). A retrospective study was conducted, analyzing the characteristics of recipients and donors, indications, surgical technique, complications and survival in 2 different stages (1991-2002 vs. 2003-2013) coinciding with the implementation of the MELD scale as a prioritization model. The most frequent indication were of hepatopathy of hepatocellular origin in 48.8%. There was a significant increase in the indications for hepatocarcinoma (8.6% and 24.1% P=0.03), and the rate of retransplantation (5.9% vs 9.6%, P=0.04). There was a change in the age of donation, going from 27.7 years in 1990 to 62.9 years in 2012 (P=0.001). The percentage of patients who did not require blood transfusion doubled (6.16 vs. 14.31%, P=.001). Survival of all patients after one, 5 and 10 years was 77, 63.5 and 51.3%, respectively.